The category of nonmalignant respiratory disease includes several conditions. Chronic obstructive pulmonary disease (COPD), pneumonia, pneumoconi-osis, and asthma are described here because they are common and an association between them and exposure to uranium is biologically plausible. COPD includes two frequently coexisting conditions: chronic bronchitis and emphysema. Chronic bronchitis is characterized by symptoms of cough and sputum production, which may be associated with poorly reversible pathologic changes in the airways. Emphysema is characterized by the progressive destruction of alveoli and permanent changes in the airways. COPD causes airflow obstruction that interferes with normal breathing. In 2005, an estimated 11.6 million adults in the United States had COPD; in 2004, 118,171 adults in the United States died from it (CDC, 2006). The primary risk factor for COPD is smoking; other risk factors include occupational exposure, sex, childhood history of respiratory infections, and family history (ALA, 2007a).
Pneumonia is an infection or inflammation of the lungs. It can affect a section or lobe of a lung (lobar pneumonia) or patches throughout both lungs (broncho-pneumonia). Risk factors for pneumococcal pneumonia include chronic illness, recent recovery from severe illness, such specific environments as chronic-care facilities, and age. In 2004, deaths in the United States attributed to pneumonia numbered 58,564 (19.9 deaths per 100,000 people) (CDC, 2007c).
Pneumoconiosis is caused by exposure to inorganic dust. It may be functionally important, representing interstitial fibrosis, or have little or no functional impact.
Asthma is a chronic inflammatory condition in which acute exacerbations are caused by airway obstruction and inflammation; it is classified as a reversible obstructive lung disease caused by increased reaction of the airways to stimuli. Asthma interferes with breathing when the airways are narrowed because of swelling of the lining, tightening of the muscle, and increased mucus secretion. Its symptoms are coughing, wheezing, and shortness of breath, and they are triggered by such stimuli as respiratory infections, environmental pollutants, temperature change, and exercise (ALA, 2007b). In 2004, an estimated 15.7 million adults in the United States had asthma, and deaths in the United States attributed to asthma numbered 3,816 (1.3 deaths per 100,000 people) (CDC, 2007b).
Nonmalignant respiratory effects may be ascertained by several methods, including the following:
Mortality: Deaths ascribed to such causes may be identified on the basis of death-certificate data.
Physician diagnosis: Medical diagnosis of a nonmalignant respiratory disease may be determined from medical records or from patient reporting of the presence of a physician diagnosis.